Uncomfortable Loudness Levels Research Articles

Impact of Migraine and Vestibular Migraine on Audiometric Profiles and Quality of Life in Patients With Tinnitus.

To investigate the clinical manifestations and complete auditory function in primary tinnitus patients with and without migraine or vestibular migraine. Retrospective case-control study. A tertiary referral center. This study enrolled 298 patients from the Kaohsiung Veterans General Hospital. All patients were diagnosed with primary tinnitus by a neurotologist between April 2020 and August 2021. Patients were excluded if they had histories of chronic otitis media, idiopathic sudden sensorineural hearing loss, Ménière's disease, skull base neoplasm, or temporal bone trauma. Twenty-five-item Tinnitus Handicap Inventory (THI), speech audiometry including speech recognition threshold, most comfortable level, uncomfortable loudness levels, dynamic range, and pure-tone audiometry. Objective hearing loss is defined as a mean threshold greater than 25 dB. Extremely elevated THI is defined as a score greater than 1 standard deviation above the mean THI. Among the 298 patients with tinnitus, 149 were women and 149 were men, with a mean age of 57.06 (range, 19.22-94.58) years.A total of 125 patients completed the THI questionnaire during their initial visit. The median THI score was 32 (95% confidence interval: 13.98-56.00), and the mean score was 34.99 with a standard deviation of 21.01. The sole contributing factor significantly associated with higher total THI score was the diagnosis of migraine or vestibular migraine (p < 0.001, odds ratio = 19.41).Tinnitus patients with migraine or vestibular migraine exhibited significantly lower mean pure-tone auditory thresholds (right 22.2 versus 29.5, p = 0.002; left 22.5 versus 30.4, p < 0.001), speech recognition threshold (right 20.0 versus 25.2, p = 0.016; left 20.2 versus 25.5, p = 0.019), and most comfortable levels values (right 46.1 versus 51.4, p = 0.007; left 46.9 versus 51.4, p = 0.021) compared with the tinnitus patients without migraine. In this population-based study, patients with primary tinnitus experienced significantly higher THI scores and exhibited concurrent symptoms, including dizziness/vertigo, cervicalgia, and migraine or vestibular migraine. Among these parameters, the diagnosis of migraine or vestibular migraine was the sole contributor to significant higher THI score.

Neural Adaptation at Stimulus Onset and Speed of Neural Processing as Critical Contributors to Speech Comprehension Independent of Hearing Threshold or Age.

Background: It is assumed that speech comprehension deficits in background noise are caused by age-related or acquired hearing loss. Methods: We examined young, middle-aged, and older individuals with and without hearing threshold loss using pure-tone (PT) audiometry, short-pulsed distortion-product otoacoustic emissions (pDPOAEs), auditory brainstem responses (ABRs), auditory steady-state responses (ASSRs), speech comprehension (OLSA), and syllable discrimination in quiet and noise. Results: A noticeable decline of hearing sensitivity in extended high-frequency regions and its influence on low-frequency-induced ABRs was striking. When testing for differences in OLSA thresholds normalized for PT thresholds (PTTs), marked differences in speech comprehension ability exist not only in noise, but also in quiet, and they exist throughout the whole age range investigated. Listeners with poor speech comprehension in quiet exhibited a relatively lower pDPOAE and, thus, cochlear amplifier performance independent of PTT, smaller and delayed ABRs, and lower performance in vowel-phoneme discrimination below phase-locking limits (/o/-/u/). When OLSA was tested in noise, listeners with poor speech comprehension independent of PTT had larger pDPOAEs and, thus, cochlear amplifier performance, larger ASSR amplitudes, and higher uncomfortable loudness levels, all linked with lower performance of vowel-phoneme discrimination above the phase-locking limit (/i/-/y/). Conslusions: This study indicates that listening in noise in humans has a sizable disadvantage in envelope coding when basilar-membrane compression is compromised. Clearly, and in contrast to previous assumptions, both good and poor speech comprehension can exist independently of differences in PTTs and age, a phenomenon that urgently requires improved techniques to diagnose sound processing at stimulus onset in the clinical routine.

Visualization and analysis of multi-channel dynamic range compression in hearing aids

One main functionality of hearing aids is restoring audibility. This means that low sound pressure levels are amplified above the elevated hearing threshold, and higher sound pressure levels do not exceed the individual uncomfortable loudness level (UCL). To this end, hearing aids provide frequency-dependent dynamic range compression which is denoted as hearing aid channels (HACs) in the recently published standard IEC 60118-16. As an increasing number of HACs, among other features, is one main feature to differentiate between price or technology levels, IEC 60118-16 includes a measurement procedure to verify the number of HACs. In this work, we verify this test procedure with a research hearing aid (RHA), and evaluate six commercial hearing aids of three different manufacturers and two technology levels. These results demonstrate the possibilities and limitations of the new test procedure. Furthermore, we introduced an extension of this test procedure with a channel-specific compression setting to overcome limitations and to get a deeper insight into the functionality of HACs in hearing aids. These results show that many HACs of commercial devices are coupled to neighboring frequencies, and that different strategies are used across manufacturers to adapt the number of HACs for different technology levels.

Electrical promontory stimulation test using a portable peripheral nerve stimulator with an ear canal electrode

ObjectiveAn intact cochlear nerve is necessary for successful cochlear implantation (CI). Although the promontory stimulation test (PST) using a promontory stimulator (PS) and a transtympanic needle electrode is invasive, it is still commonly used to verify cochlear nerve function. PSs are currently unavailable because they are no longer manufactured; however, considering that PST continues to be beneficial in certain situations, alternative equipment is needed. The PNS-7000® (PNS) was developed as a neurologic instrument for stimulating the peripheral nerves. This study investigated the usefulness of the ear canal stimulation test (ECST) using PNS with a silver ball ear canal electrode, which is a new noninvasive alternative technique to the PST. MethodsECST was performed from November 2013 to December 2018 using PS and PNS for patients with severe to profound sensorineural hearing loss. The electrical threshold, most comfortable loudness level, uncomfortable loudness level, dynamic range, and gap detection were measured in the ECST. The results of these measured PNS items were compared with PS. ResultsECST was performed in 61 ears of 35 patients (age, 59.9 ± 20.1 years) using PS and PNS. The sound sensation was elicited in 51 (83.6%) and 52 (85.2%) ears with PS and PNS, respectively. All items excluding GAP were measured in 46 (75%) and 43 (70%) ears at 50 and 100 Hz, respectively. GAP was measured in 33 ears by the ascending and descending methods using PS and PNS. Spearman's rank-order correlation coefficient revealed a significant positive linear correlation between the PS and PNS results in all measurements. No significant difference was found between the PS and PNS thresholds in all measured items. ConclusionsPNS is a useful instrument for performing ECST as a new alternative to PS. ECST using a silver ball electrode is a less invasive and easier test than PST.

Exploding Head Syndrome among patients seeking help for tinnitus and/or hyperacusis at an Audiology Department in the UK: A preliminary study.

Exploding Head Syndrome (EHS) is characterised by hearing a sudden loud noise or experiencing a sense of explosion in head during the transition of sleep-wake or wake-sleep. The experience of EHS shares similarities with tinnitus, where an individual perceives a sound without any sound source. To the authors' knowledge, the possible relationship between EHS and tinnitus has not been explored. Preliminary assessment of prevalence of EHS and its related factors among patients seeking help for tinnitus and/or hyperacusis. Retrospective cross sectional study Study sample: 148 consecutive patients who sought help for tinnitus and/or hyperacusis at an audiology clinic in the UK. The data regarding demographics, medical history, audiological measures and self-report questionnaires were collected retrospectively from the patients' records. Audiological measures comprised of pure tone audiometry and uncomfortable loudness levels. The self-report questionnaires which were administered as a part of standard care comprised of the tinnitus handicap inventory (THI), numeric rating scale (NRS) of tinnitus loudness, annoyance and effect on life, Hyperacusis Questionnaire (HQ), Insomnia Severity Index (ISI), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9). To establish presence of EHS, participants were asked "Do you ever hear a sudden, loud noise or feel a sense of explosion in your head at night?". EHS was reported by 8.1% of patients with tinnitus and/or hyperacusis (n = 12 out of 148). The patients with and without EHS were compared, but no significant relationships were found, between the presence of EHS and age, gender, tinnitus/hyperacusis distress, symptoms of anxiety or depression, sleep difficulties, or audiological measures. The prevalence of EHS in a tinnitus and hyperacusis population is similar to that in the general population. While there does not seem to be any association with sleep or mental factors, this might be due to the limited variability in our clinical sample (i.e., most patients exhibited high level of distress regardless of EHS). Replication of the results in a larger sample with more variety of symptom severity is warranted.

Further Evaluation of a Protocol for Integrated Speech Audiometry

When a bilateral evaluation is conducted with the integrated speech protocol described in Punch and Rakerd (2019), testing for the first ear concludes with a measurement of the uncomfortable loudness level for speech (UCL). The purpose of this study was to assess the possibility that exposure to the high speech intensities required for that UCL test might bias the subsequent measurement of a listener's most comfortable loudness level for speech (MCL) in the opposite ear. Across 32 test runs, the left and right ear MCLs were established for 16 young adult listeners with normal hearing (five women, 11 men). The MCL assessed on each test run was measured twice. The first measurement was made at the start of the run and before a full integrated speech evaluation was conducted in the opposite ear (pretest); the second was made after that evaluation (posttest). The difference between the MCL means measured on the pretest (37.7 dB) and the posttest (38.5 dB) was less than 1 dB, and it did not approach statistical significance, t(15) = 0.69, p = .50. There was no evidence that UCL testing done in one ear on a bilateral speech test will have carryover effects that bias the subsequent measurement of a listener's MCL in the other ear. The results, therefore, support the potential clinical use of an integrated protocol when conducting bilateral speech audiometric evaluations.

Psychometric evaluation of the 4C tinnitus management questionnaire for patients with tinnitus alone or tinnitus combined with hyperacusis

Objective To assess the psychometric properties of a new questionnaire evaluating patients’ confidence in managing their tinnitus, the 4C tinnitus management questionnaire (4C), which was designed to be used in the process of cognitive behavioural therapy. Design Retrospective cross-sectional based on patient records. Study samples 99 consecutive patients who sought help for tinnitus (with or without hyperacusis) from an audiology clinic in the UK. Pure tone average (PTA) hearing thresholds, Uncomfortable Loudness Levels (ULLs), and responses to the 4C questionnaire, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T) questionnaire were gathered from the records of patients held at the audiology department. Results Cronbach’s alpha for the 4C was 0.91, indicating high internal consistency. Exploratory factor analysis suggested a one-factor solution. Discriminant validity was supported by weak correlations between 4C scores and PTA across ears and ULLmin (the across-frequency average ULL for the ear with lower average ULL). Convergent validity was supported by moderate correlations between 4C scores and scores for the THI, HQ, and SAD-T. Conclusions The 4C is an internally consistent questionnaire with high convergent and discriminant validity, which can be used to assess patients’ confidence in managing their tinnitus.

Validity and reliability study of the Khalfa's hyperacusis questionnaire with using ULL in tinnitus patients.

This study aims to investigate the validity and reliability of the Khalfa's hyperacusis questionnaire (HQ) in Turkish tinnitus patients with hyperacusis using uncomfortable loudness levels (ULLs) and to determine a cutoff score for tinnitus patients specifically. One hundred and forty subjects with a mean age ± SD of 45.27 ± 14.43years ranging from 18 to 75 participated in the study. HQ and ULLs were used as measures of hyperacusis. The participants were divided into two groups due to ULLs ≤ 90dB in one or both ears (Group 1) and 56 participants have ULLs > 90dB (Group 2). The mean HQ score of the participants was 19.55 ± 7.18 points, Group 1 (n = 84) HQ mean score was 21.97 ± 7.08, and Group 2 (n = 56) 15.91 ± 5.56 points, and the cutoff point was found 16.50. Statistically significant differences were found between the groups in total HQ (p < 0.001), attention, social, and emotional subscales of HQ. Hyperacusis questionnaire using with ULLs is a precise tool for the steps of identifying, categorizing, and managing the hyperacusis in patients with tinnitus. However, the effect of the tinnitus on hyperacusis should be considered, because it causes additional problems.

Congenital Nonprofound Bilateral Sensorineural Hearing Loss in Children: Comprehensive Characterization of Auditory Function and Hearing Aid Benefit.

A prospective cross-sectional design was used to characterize congenital bilateral sensorineural hearing loss (SNHL). The underlying material of >30,000 consecutively screened newborns comprised 11 subjects with nonprofound, alleged nonsyndromic, SNHL. Comprehensive audiological testing was performed at ≈11 years of age. Results showed symmetrical sigmoid-like median pure-tone thresholds (PTTs) reaching 50–60 dB HL. The congenital SNHL revealed recruitment, increased upward spread of masking, distortion product otoacoustic emission (DPOAE) dependent on PTT (≤60 dB HL), reduced auditory brainstem response (ABR) amplitude, and normal magnetic resonance imaging. Unaided recognition of speech in spatially separate competing speech (SCS) deteriorated with increasing uncomfortable loudness level (UCL), plausibly linked to reduced afferent signals. Most subjects demonstrated hearing aid (HA) benefit in a demanding laboratory listening situation. Questionnaires revealed HA benefit in real-world listening situations. This functional characterization should be important for the outline of clinical guidelines. The distinct relationship between DPOAE and PTT, up to the theoretical limit of cochlear amplification, and the low ABR amplitude remain to be elucidated. The significant relation between UCL and SCS has implications for HA-fitting. The fitting of HAs based on causes, mechanisms, and functional characterization of the SNHL may be an individualized intervention approach and deserves future research.

Transient decrease in sound tolerance levels following hearing deprivation in normal-hearing subjects

ObjectiveTo determine the circadian influence on sound sensitivity produced by temporal hearing deprivation in healthy normal human subjects. DesignParticipants underwent bilateral earplugging before completion of anthropometry, the author's developed questionnaire, the Hamilton Anxiety and Depression Inventory, pure tone audiometry (PTA), stapedial reflex thresholds (SRT), distortion products otoacoustic emissions input/output (DPOAE-I/O), and uncomfortable loudness levels (ULLs). Afterward, the participants were randomly divided into group A, starting at 8:00 a.m. and finishing at 8:00 p.m., and group B, starting at 4:00 p.m. and ending at 4:00 a.m. Serum cortisol levels and audiological test results were obtained at the beginning and end of the session and 24-h free urinary cortisol levels were measured. Study sampleThirty healthy volunteers. ResultsPTA was 2.68 and 3.33 dB HL in groups A and B, respectively, with no statistical difference between them. ULLs were significantly lower in group A compared to group B, with an average of 8.1 dB SPL in group A and 3.3 dB SPL in group B (p < 0.0001). A SRT shift was observed in group A, with no difference in group B, and a night shift in DPOAE-I/O in group B. ConclusionsReduced loudness tolerance is demonstrated during daytime hearing deprivation in contrast to nighttime; this may be due to increased central gain in the awake cortex.

Audiological and Other Factors Predicting the Presence of Misophonia Symptoms Among a Clinical Population Seeking Help for Tinnitus and/or Hyperacusis.

This paper evaluates the proportion and the audiological and other characteristics of patients with symptoms of misophonia among a population seeking help for tinnitus and/or hyperacusis at an audiology clinic (n = 257). To assess such symptoms, patients were asked “over the last 2 weeks, how often have you been bothered by any of the following problems? Feeling angry or anxious when hearing certain sounds related to eating noises, lip-smacking, sniffling, breathing, clicking sounds, tapping?”. The results of routine audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Measures included: pure tone audiometry, uncomfortable loudness levels (ULLs), and responses to the tinnitus impact questionnaire (TIQ), the hyperacusis impact questionnaire (HIQ), and the screening for anxiety and depression in tinnitus (SAD-T) questionnaire. The mean age of the patients was 53 years (SD = 16) (age range 17 to 97 years). Fifty four percent were female. Twenty-three percent of patients were classified as having misophonia. The presence and frequency of reporting misophonia symptoms were not related to audiometric thresholds, except that a steeply sloping audiogram reduced the likelihood of frequent misophonia symptoms. Those with more frequent misophonia symptoms had lower values of ULLmin (the across-frequency average of ULLs for the ear with lower average ULLs) than those with less frequent or no reported symptoms. The reported frequency of experiencing misophonia symptoms increased with increasing impact of tinnitus (TIQ score ≥9), increasing impact of hyperacusis (HIQ score >11), and symptoms of anxiety and depression (SAD-T score ≥4). It is concluded that, when assessing individuals with tinnitus and hyperacusis, it is important to screen for misophonia, particularly when ULLmin is abnormally low or the TIQ, HIQ or SAD-T score is high. This will help clinicians to distinguish patients with misophonia, guiding the choice of therapeutic strategies.

Psychometric Evaluation of the Hyperacusis Impact Questionnaire (HIQ) and Sound Sensitivity Symptoms Questionnaire (SSSQ) Using a Clinical Population of Adult Patients with Tinnitus Alone or Combined with Hyperacusis.

Hyperacusis can be defined as an intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. It is important to assess symptoms of sound intolerance and their impact on the patient's life, so as to evaluate the need for treatment and to assess the effectiveness of treatments. The aim was to evaluate the psychometric properties of the Hyperacusis Impact Questionnaire (HIQ), and the Sound Sensitivity Symptoms Questionnaire (SSSQ). The 8-item HIQ focuses on assessing the impact of hyperacusis on the patient, while the 5-item SSSQ is designed to assess the type and severity of sound intolerance symptoms. This was a retrospective cross-sectional study. In total, 266 consecutive patients who attended a Tinnitus and Hyperacusis Therapy Clinic in the United Kingdom within a 6-month period. Fifty-five percent were female. The average age was 54 years (standard deviation = 16 years). Data were collected retrospectively from the records of patients held at the audiology department. Audiological measures were pure-tone audiometry and Uncomfortable Loudness Levels (ULLs). Questionnaires administered in addition to the HIQ and SSSQ were: Tinnitus Handicap Inventory, Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus. Exploratory factor analysis suggested one-factor solutions for both the HIQ and SSSQ. Multiple-causes multiple-indicators (MIMIC) models showed some small influences of gender but negligible effects of age for both the HIQ and SSSQ. Receiver Operating Characteristic (ROC) analysis showed no significant effects of covariates on the ROC curves. Cronbach's α was 0.93 for the HIQ, and 0.87 for the SSSQ, indicating high internal consistency. Convergent validity was supported by moderate correlations between HQ and HIQ scores and between SSSQ scores and ULLs. The HIQ and SSSQ are internally consistent questionnaires that can be used in clinical and research settings.

Tinnitus, sound intolerance, and mental health: the role of long-term occupationalnoise exposure.

Whereas chronic noise exposure (CNE) is a known risk factor for tinnitus, little is known about how a history of CNE impacts tinnitus characteristics and its comorbid symptoms. Seventy-five participants with chronic tinnitus (59m/16f, 22-78years, 48 with sensory-neural hearing loss, and 27 with a normal audiogram) including 43 individuals with (Tin-CNE group) and 32 without (Tin group) a history of long-term occupational noise exposure were studied. Tinnitus characteristics were rated by a visual analog scale, and tinnitus comorbid symptoms were scored using self-assessment questionnaires. The Tin-CNE group showed reduced uncomfortable loudness level (ULL), sound tolerance, and quality of life (QoL), and increased tinnitus loudness, tinnitus handicap, anxiety, depression, insomnia severity, and tinnitus annoyance scores compared to the Tin group. Higher tinnitus loudness and a lower anxiety score were observed in participants with hearing loss relative to those without. Using a stepwise regression model also showed that tinnitus-related characteristics, hyperacusis, and tinnitus comorbid symptoms enhance one another. The findings were in support of accumulative evidence indicating the adverse auditory and non-auditory effects of CNE, including exacerbated sound intolerance and tinnitus-related psychiatric symptoms. The results also showed that tinnitus alone can affect mental health regardless of hearing loss.

Comparison of Uncomfortable Loudness Level in Stapedotomy with or without Stapedial Tendon Preservation

Background: Otosclerosis is one of the commonest diseases of the ear mostly involves the otic capsule. Most often otosclerotic foci appear in stapes region leading to stapes fixation, predominantly affect the adolescence female. The most common presenting symptom of clinical otosclerosis is conductive deafness. The mainstay of treatment for otosclerosis is surgery. Surgical options include stapedectomy, stapedotomy with or without stapedial tendon preservation. The latter being is the procedure of choice. Aim: The aim of this study is to compare the outcome of uncomfortable loudness level in stapedotomy with or without stapedial tendon preservation. Methods: A prospective observational study was conducted in the Department of Otolaryngology-Head &amp; Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months in patients with otosclerosis. Total 30 subjects were selected based on the inclusion and exclusion criteria. All patients were assessed pre-operatively by clinical examination, otoscopy and microscopic examination. Hearing was assessed by pure tone audiometry. Uncomfortable level and stapedial reflex threshold were tested in all cases. The selected cases were placed into two groups. Stapedial tendon resection in Group-I and stapedial tendon preservation in Group-II. Post-operative follow up was done at 3 months and 6 months. Hearing and uncomfortable loudness level were evaluated with PTA during follow up by calculating the average of 500Hz, 1000Hz, 2000Hz and 4000HZ. The data were calculated manually. The statistical significance was set to P&lt; 0.05. Results of the study were expressed as mean, standard deviation (± SD), frequency and percentages. Means and standard deviations were reported for continuous variables. Frequencies and percentages were reported for categorical variables. Unpaired Student’s t test was done to compare the continuous variables and Chi Square test was done to compare the categorical variables. Results: In this study preoperative average ABG for group I and group II were 35 ± 4.57 dB and 34 ± 4.17 dB respectively. In group I, post operative average ABG after 3 months and 6 months were 14 ± 3.7 dB and 13±3.3 dB respectively. Post operative average ABG after 3 months was 13 ± 5.7 dB and was 12 ± 4.4 dB for group II. But the hearing improvement between two groups was not statistically significant. In case of preoperative mean UCL was 95 ± 1.8 dB and 96 ± 2.5 dB for group I and group II respectively. Postoperative mean UCL after 3 months was 96 ± 3.57 dB and after 6 months was 99 ± 6.28 dB in group I. For group II, postoperative mean UCL after 3 months and 6 months was 107±4.2 dB and 113 ± 3.2 dB respectively. Here mean UCL was on average 11 dB higher for group II in 3 months and additional 6 dB improvement noted after 6 months, but show minimal change in group I. This finding was statistically significant. Conclusion: Preservation of the stapedial tendon is the choice in the surgical treatment of otosclerosis which helps to improve functional outcomes as well as to provide the more physiologic protection of middle ear. Postoperative discomfort threshold levels were increased in patients who had their stapedial tendon restored. Bangladesh J Otorhinolaryngol 2021; 27(2): 117-123

Effects of long-term azithromycin therapy on auditory functions in children with chronic respiratory diseases

Background and objectivesIn recent years, long-term azithromycin (AZT) use has been increased in pediatric patients with chronic respiratory tract problems. In this study, we aimed to assess auditory functions in children on long-term AZT therapy. MethodThe study included 43 patients who received long-term AZT treatment and 27 age-matched, healthy controls. In the study and control groups, ear-nose-throat examination, pure tone audiometry, speech recognition threshold (SRT), speech discrimination score (SDS), uncomfortable loudness level (UCL), acoustic reflex tests, and otoacoustic emission tests were performed. The test results were statistically compared between groups. ResultsMean age was 11.3 ± 0.56 years in the study group and 9.3 ± 3.07 years in the control group. The medain hearing examination was 8 months after end of AZT treatment (Ranged: 1–12 months). No significant difference was found in normal- and high-frequency audiogram tests at any frequency between study and control groups. Also, no significant difference was found in distortion product otoacoustic emissions (DPOAE) and transient evoked otoacoustic emissions (TEOAE) tests between groups. Also, there was no significant difference in acoustic reflex, SRT, SDS, and UCL test results between study and control groups. ConclusionThis is the first study assessing auditory functions comprehensively in pediatric patients who received long-term AZT therapy. In this study, it was shown that long-term AZT use had no deleterious effect on auditory function tests.

Evaluation and Management of Misophonia Using a Hybrid Telecare Approach: A Case Report.

Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.

Decreased Sound Tolerance in Tinnitus Patients

(1) Background: Decreased sound tolerance is a significant problem in tinnitus sufferers. The aim of the study was to evaluate the relationship between tinnitus and decreased sound tolerance (hyperacusis and misophonia). (2) Methods: The study sample consisted of 74 patients with tinnitus and decreased sound tolerance. The procedure comprised patient interviews, pure tone audiometry, impedance audiometry, measurement of uncomfortable loudness levels, and administration of the Hyperacusis Questionnaire, Tinnitus Handicap Inventory, and Visual Analogue Scales. (3) Results: The majority (69%) of the patients reported that noise aggravated their tinnitus. The correlation between tinnitus and hyperacusis was found to be statistically significant and positive: r = 0.44; p < 0.01. The higher the tinnitus severity, the greater the hyperacusis. There was no correlation between misophonia and hyperacusis (r = 0.18; p > 0.05), or between misophonia and tinnitus (r = 0.06; p > 0.05). (4) Conclusions: For tinnitus patients the more significant problem was hyperacusis rather than misophonia. The diagnosis and treatment of decreased sound tolerance should take into account not only audiological, but also psychological problems of the patients.

Preliminary Examination of the Incidence of and Factors Related to Hearing Tinnitus in Dreams

The aim of this study was to assess the incidence of the perception of tinnitus in dreams among patients seeking help for tinnitus and/or hyperacusis and to assess whether this is related to the severity of tinnitus and/or hyperacusis. This was a retrospective study. The data for 148 consecutive adult patients who attended a tinnitus/hyperacusis clinic in the United Kingdom were included. The average age of the patients was 56 years (standard deviation [SD] = 15 years). Data were collected retrospectively from their records held at the audiology department. Audiological measures were pure-tone audiometry and uncomfortable loudness levels. Questionnaires administered were: Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire, Insomnia Severity Index, Visual Analogue Scale (VAS) of tinnitus loudness, annoyance, and effect on life, Generalized Anxiety Disorder, and Patient Health Questionnaire. Patients were also asked "If you dream have you ever perceived tinnitus in your dreams?" Five percent of patients (7/148) reported hearing tinnitus in their dreams. There was a nonsignificant trend for patients who reported hearing tinnitus in their dreams to be younger (mean age = 46 years, SD = 15 years) than those who did not (mean age = 57 years, SD = 15 years). The mean scores for the THI and VAS for effect of tinnitus on life were significantly higher (worse) for patients who reported hearing tinnitus in their dreams than for those who did not. A small proportion of patients reported hearing tinnitus in their dreams and this was associated with higher tinnitus handicap as measured via the THI and more effect of tinnitus on life as measured via the VAS. These preliminary results may indicate that those who are greatly affected by their tinnitus are more likely to hear it in their dreams or to be woken by it. Future studies should use methods that can be used to reliably assess if and when tinnitus is perceived during the sleep cycle, using more physiological measures and testing a wider population.

Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms.

The aim was to assess the internal consistency and convergent and discriminant validity of a new questionnaire for hyperacusis, the Inventory of Hyperacusis Symptoms (IHS; Greenberg & Carlos 2018), using a clinical population. This was a retrospective study. Data were gathered from the records of 100 consecutive patients who sought help for tinnitus and/or hyperacusis from an audiology clinic in the United Kingdom. The average age of the patients was 55 years (SD = 13 years). Audiological measures were the pure-tone average threshold (PTA) and uncomfortable loudness levels (ULL). Questionnaires administered were: IHS, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire-9. Cronbach's alpha for the 25-item IHS questionnaire was 0.96. Neither the total IHS score nor scores for any of its five subscales were correlated with the PTA of the better or worse ear. This supports the discriminant validity of the IHS, as hyperacusis is thought to be independent of the PTA. There were moderately strong correlations between IHS total scores and scores for the HQ, Tinnitus Handicap Inventory, Generalized Anxiety Disorder, and Patient Health Questionnaire-9, with r = 0.58, 0.58, 0.61, 0.54, respectively. Thus, although IHS scores may reflect hyperacusis itself, they may also reflect the coexistence of tinnitus, anxiety, and depression. The total score on the IHS was significantly different between patients with and without hyperacusis (as diagnosed based on ULLs or HQ scores). Using the HQ score as a reference, the area under the receiver operating characteristic for the IHS was 0.80 (95% confidence interval = 0.71 to 0.89) and the cutoff point of the IHS with highest overall accuracy was 56/100. The corresponding sensitivity and specificity were 74% and 82%. The IHS has good internal consistency and reasonably high convergent validity, as indicated by the relationship of IHS scores to HQ scores and ULLs, but IHS scores may also partly reflect the co-occurrence of tinnitus, anxiety, and depression. We propose an IHS cutoff score of 56 instead of 69 for diagnosing hyperacusis.

Within-Subject Comparisons of the Auditory Brainstem Response and Uncomfortable Loudness Levels in Ears With and Without Tinnitus in Unilateral Tinnitus Subjects With Normal Audiograms.

To evaluate whether cochlear synaptopathy is a common pathophysiologic cause of tinnitus in individuals with normal audiograms. Prospective study. Tertiary referral center. We enrolled 27 subjects with unilateral tinnitus and normal symmetric hearing thresholds, and 27 age- and sex-matched control subjects with normal symmetric hearing thresholds. We measured 1) the amplitudes of waves I and V with 90 dB nHL click stimuli in quiet conditions; 2) the latency shift of wave V with 80 dB nHL click stimuli in background noise, varying from 40 dB HL to 70 dB HL; and 3) uncomfortable loudness levels (UCLs) at 500 Hz and 3000 Hz pure tones. There were no significant differences in the wave V/I amplitude ratio or the latency shift in wave V with increasing noise levels among the tinnitus ears (TEs), nontinnitus ears (NTEs), and control ears. There were no significant differences in UCLs at 500 Hz or 3000 Hz between TEs and NTEs, but the UCLs were lower in TEs (mean 111.3 dB or 104.1 dB) and NTEs (mean 109.4 dB or 100.6 dB) than in control ears (mean 117.9 dB or 114.1 dB, p < 0.017). No subject met our criteria for cochlear synaptopathy or increased central gain in terms of all three parameters. Based on these results for UCL, increased central gain is a major mechanism of tinnitus in humans with normal audiograms. However, this compensatory mechanism for reduced auditory input may originate from other pathophysiologic factors rather than from cochlear synaptopathy.